When dental, hearing, vision and all other out-of-pocket expenses are included, the total retirement health care bill rises to $377,412.

For retirees counting on Social Security income, HealthView Services’ Retirement Health Care Cost Index shows a 66-year-old couple retiring this year will need 57% of their Social Security to cover total health care costs. A 55-year-old couple retiring in 10 years will require 88%, and a 45-year-old couple, 116%. These calculations are based on Social Security Trustees’ projections of a 3.1% cost-of-living adjustment (COLA) in 2017 and 2.7% thereafter.

The paper addresses savings shortfalls for retirees who rely on income replacement ratios (IRR). The data indicates that using an IRR-based savings approach will only cover a portion of retirement medical expenses. A 55-year-old man who has met his 80% IRR goal will, for example, need an additional $25,679 investment growing at 6% annually to close this gap.

A key cost driver is health care inflation in retirement. Overall retirement health care costs are projected to have increased by 7.3% between 2015 and 2016, driven in part by a 16.1% increase in Medicare Part B premiums over the same period. Over the next 20 years, HealthView projects a more modest average annual inflation rate of 5.1% for retirement health care expenses. This is consistent with forecasts from the Centers for Medicare and Medicaid, which expects at least eight years of health care inflation between 5% and 7%.

Other findings include the cost disparity between genders, driven by a greater average life expectancy for women. A 30-year-old female retiring at 65 can expect to pay $548,098 (in today’s dollars) in total lifetime retirement health care expenses—$118,632 more than a male of the same age (based on life expectancies of 91 and 87, respectively).

Similarly, healthy Americans can expect to pay significantly more for retirement medical services than those suffering from a chronic disease that may impact their lifespans. A healthy male or female can expect to pay almost twice as much for lifetime health care in retirement than someone who is diabetic.

“Few Americans have taken steps toward addressing medical expenses in retirement, and most do not understand Medicare costs,” says Ron Mastrogiovanni, founder and CEO of HealthView Services. “Our data shows the significant impact of rising health care costs and the importance of planning for them.”